Pharmacological activities of berberine and strategies to improve its oral bioavailability / 药学学报

Berberine is a naturally occurring benzylisoquinoline alkaloid with a wide range of pharmacological activities, such as antibacterial, anticancer, hypolipidemic, antidiabetic and antidiarrheal. Although berberine has a wide range of curative effects, the extremely low bioavailability (< 1%) limits its clinical application. Pure berberine preparations have not yet been approved for any specific disease. The low oral bioavailability of berberine is mainly due to poor solubility caused by self-aggregation under acidic conditions, low permeability, P-glycoprotein (P-gp)-mediated efflux, and liver and intestine metabolism. To improve the oral bioavailability of berberine, researchers have adopted a variety of strategies, including the application of various nano-delivery systems, penetration enhancers and P-gp inhibitors, structural modifications, and development of berberine derivatives. Improving the oral bioavailability of berberine can improve the pharmacological activity of berberine, reduce the dosage, and then reduce the toxic and side effects. This review summarized the various pharmacological activities, metabolism progress and pharmacokinetic characteristics of berberine, the newly discovered berberine target intestinal microbiota and focused on the strategies to improve the oral bioavailability of berberine by improving solubility and permeability, inhibiting P-gp efflux, and structural modification. The research on berberine was prospected, which provided guidance for the in-depth study of berberine.

Effect of macrophage dysfunction on diabetic wound healing: a review of research progress / 中华显微外科杂志

Macrophages play a crucial role in inflammatory, proliferative and reconstructive phases in wound healing. A dysfunction of macrophage could lead to a delay of healing. As the most common type of chronic wounds, the diabetic wound may ultimately result in a delayed or failed wound healing due to a high glucose microenvironment and abnormal metabolic environment. Such abnormal metabolic environment may lead to the aberrant macrophage polarization, abnormal secretion of cytokines and aberrant phagocytic function hence cause prolonged inflammation with excessive oxidative stress reaction. As the consequence, the inflammatory phase in diabetic wound is lengthy while the proliferative and reconstructive phases are usually delayed. The diabetic wound may result in enormous financial burden to patients, the healthcare and the society. This study briefly reviewed the recent research progresses at home and abroad, and analysed and summarized the roles of the dysfunction of macrophage polarization, secretion and phagocytosis in the process of diabetic wound healing.

Automated grading of glioma based on density and atypia analysis in whole slide images / 生物医学工程学杂志

Glioma is the most common malignant brain tumor and classification of low grade glioma (LGG) and high grade glioma (HGG) is an important reference of making decisions on patient treatment options and prognosis. This work is largely done manually by pathologist based on an examination of whole slide image (WSI), which is arduous and heavily dependent on doctors' experience. In the World Health Organization (WHO) criteria, grade of glioma is closely related to hypercellularity, nuclear atypia and necrosis. Inspired by this, this paper designed and extracted cell density and atypia features to classify LGG and HGG. First, regions of interest (ROI) were located by analyzing cell density and global density features were extracted as well. Second, local density and atypia features were extracted in ROI. Third, balanced support vector machine (SVM) classifier was trained and tested using 10 selected features. The area under the curve (AUC) and accuracy (ACC) of 5-fold cross validation were 0.92 ± 0.01 and 0.82 ± 0.01 respectively. The results demonstrate that the proposed method of locating ROI is effective and the designed features of density and atypia can be used to predict glioma grade accurately, which can provide reliable basis for clinical diagnosis.

Dialectical analysis of heparin residue in perioperative period of off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

Objective:To investigate the best neutralization ratio of protamine and heparin during off-pump coronary artery bypass grafting(OPCABG) by analyzing the advantages and disadvantages of heparin residue after OPCABG.Methods:From July 2018 to January 2019, 112 patients undergoing elective OPCABG were included in this study. The patients’ whole blood was drawn at 2 time points, including before entering operating room and entering intensive care unit, to receive thrombelastography(TEG) and heparinase-modified thromboelastography(hmTEG) . Conventional coagulation indexes such as activated coagulation time(ACT) were also detected. All the patients were divided into 3 groups, the non-heparin residue group(30 cases), heparin residue group 1(42 cases) and heparin residue group 2(40 cases) according to the laboratory results of TEG, hmTEG and ACT. We observed the dosage of each group of protamine and heparin, as well as the ratio of heparin and protamine. The changes of R time in TEG and ACT between 3 groups were analyzed and compared. Postoperative chest tube drainage at postoperative 12 h and 48 h, cTnI peak value, incidence of perioperative myocardial infarction(MI), incidence of reoperation and poor wound healing, amount of blood loss and transfusion, and acute renal injury were compared between the 3 groups.Results:No significant trio-group differences existed in basic clinical characteristics(all P>0.05). Postoperative R(CKH)time was similar in the 3 groups( P>0.05). Comparing with heparin residue group 1 and heparin residue group 2, the ACT after protamine neutralizing heparin and postoperative R time were decreased, the dosage of protamine, ratio of heparin and protamine, cTnI peak value were increased in the non-heparin residue group( P<0.05). Comparing with heparin residue group 2, the dosage of heparin, postoperative chest tube drainage at postoperative 12h and 48h, amount of blood transfusion and transfusion probability were significantly decreased in non-heparin residue group( P<0.05), but compared with group 1 of heparin residue, there was no significant difference in the above indexes( P>0.05). The perioperative myocardial infarction, incidence of reoperation and poor wound healing, postoperative acute renal injury and time of in ICU stay showed no significant differences between the 3 groups( P>0.05). Conclusion:Moderate heparin residue after OPCAB suggests that it has myocardial protective effect, and does not significantly increase the risk of bleeding. A large number of heparin residues can affect the coagulation function and lead to bleeding tendency, increase the amount of blood loss and transfusion. It is reasonable to make ACT after protamine neutralize heparin higher than the level of ACT before operation, and not higher than 20% of the level before operation.

Effect of Xiao Chaihutang on NF-κB Signaling Pathway in Synovial Tissue of CFA Rats / 中国实验方剂学杂志

Objective:To observe the expression of tumor necrosis factor receptor-associated death domain (TARDD), nuclear transcription factor-κB inhibiting protein α(IκBα)IκB kinase-α (IKKα) and nuclear transcription factor (NF)-κB p65 protein in the NF-κB signaling pathway of synovial tissues of complete Freund's adjuvant (CFA) rats after treatment with Xiao Chaihutang (XCHT). Method:In animal experiments, SPF health adult female Wistar rats were used to prepare the CFA animal model of rats with rheumatoid arthritis with Freund's complete adjuvant and cattle Ⅱ collagen type. According to the random number table, the rats were randomly divided into the normal group, the model group, the low-dose XCHT group, the medium-dose XCHT group, the high-dose XCHT group, and the Tripterygium glucosides group. The drugs were given at 7 d after the model was built. Both normal group and model group were given water for injection,and low-dose XCHT group(5.94 g·kg-1),medium-dose XCHT group(11.88 g·kg-1),high-dose XCHT group(23.76 g·kg-1),Tripterygium glucosides group(0.006 3 g·kg-1) were given corresponding drugs by gavage for three times a day, 2 mL/time. The histopathology of rat ankle joint was observed, and the protein expressions of TARDD,IKKα,IκBα,NF-κB p65 in the NF-κB signaling pathway in synovial tissue of CFA rats were detected by Western blot. Result:With the increase of the dosage of XCHT, the histopathological score of the right posterior ankle joint of the experimental rats was increased. And in the protein expressions of TARDD,IKKα,IκBα,NF-κB p65 in NF-κB signaling pathway in Synovial Tissue of CFA rats, compared with the model group, the statistical results of the low-dose XCHT group showed decreased protein expressions (PPPα, IκB α, NF-κB p65 in the NF-κB signaling pathway were significantly increased (PPα, IκBα, NF-κB p65 key protein expressions in the NF-κB signaling pathway and protein expressions in low-dose XCHT group were obviously lower (PPConclusion:This study shows that as the dose of Xiao Chaihutang increases, it could effectively improve synovitis, and suppress the expressions of key proteins in the inflammatory signaling pathway of NF-κB, thereby preventing inflammation and suppressing bone erosion.

Protective Effect of Linggui Zhugan Tang on Bone Injury in ob/ob Mice Based on Gut Microbiota / 中国实验方剂学杂志

Objective:To observe the effect of Linggui Zhugan Tang on gut microbiota in ob/ob mice, in order to explore whether its bone protective effect is related to its regulatory effect of gut microbiota. Method:The ob/ob mice were divided into control group, model group, Linggui Zhugan Tang group, and Atorvastatin group. After administration for 4 weeks, morphological changes in intestine and bone were observed by htoxylin eosin(HE) staining. The protein expression of alkaline phosphatase(ALP) was detected by Western blot in bone. The expression of farniol X receptor(FXR) was detected by in immunofluorescence staining. And the content of interleukin-6(IL-6) in serum was analyzed by the enzyme-linked immunosorbent assay(ELISA) method. Gut microbiota was analyzed by 16S rRNA. Result:Compared with control group, the trabecular bone of the femur became thinner, the bone marrow cavity was infiltrated with fat, and the epithelium of the small intestine was damaged in the model group. The protein expressions of ALP and FXR decreased, while the content of IL-6 in serum was increased in the model group. Compared with model group, the protein expressions of ALP and FXR increased, while the content of IL-6 in serum was decreased in the Linggui Zhugan Tang group. At the genus level, compared with control group, the abundance of Lachnospiraceae_UCG-001 increased (PBacteroidales_S24-7_group decreased in model group (PLachnospiraceae_UCG-001 was positively correlated with the weight of body (r=0.661), while norank_f__Bacteroidales_S24-7_group was negatively correlated with the weight of body (r=-0.622). Conclusion:Linggui Zhugan Tang has a protective effect on bone injury in ob/ob mice, and its mechanism may be related to its regulation of gut microbiota.

Association of workplace loneliness, job burnout and conscientiousness in teachers of special education in Guangxi / 中国职业医学

OBJECTIVE: To explore the association of workplace loneliness, job burnout and conscientiousness in teachers of special education. METHODS: A total of 344 teachers of special education from Guangxi Zhuang Autonomous Region were selected as study subjects by judgment sampling method. The questionnaires of Workplace Loneliness Scale, Maslach Burnout Inventory and Conscientiousness Scale of Big Five Inventory were used to conduct the survey. The mediating role of job burnout in workplace loneliness and conscientiousness was analyzed. RESULTS: The total score of workplace loneliness was 32.6±8.3. The median total score of job burnout and conscientiousness was 31.0 and 30.6 respectively. Partial correlation analysis showed that the dimensions of job burnout were positively correlated with the total score of workplace loneliness and all its dimension scores, and negatively correlated with conscientiousness score(P<0.01). The degree of explanation for the change of workplace loneliness and job burnout on conscientiousness were 9.0% and 17.0% respectively. CONCLUSION: Job burnout plays a partial mediating role in workplace loneliness and conscientiousness in teachers of special education. Reducing workplace loneliness and job burnout can help improve the conscientiousness of teachers of special education.

Clinical analysis of seven cases of rare hemolytic disease of the newborn / 中华儿科杂志

Objective@#To summarize the clinical features of 7 rare cases of hemolytic disease of newborn (HDN), and to improve the understanding of rare HDN.@*Methods@#Data of clinical information, laboratory findings, treatments and outcomes were collected and analyzed for four cases with HDN due to anti-M, two cases due to anti-Kidd, and one case due to anti-Duffy. All of them were admitted to the Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medial University from July 2007 to June 2017.@*Results@#Among the four MN hemolytic babies, two were males and two were females. Jaundice was found in three cases. Two cases had hyperbilirubinemia, one of them had severe hyperbilirubinemia. All the four cases developed anemia, including severe anemia in three cases. Two cases of Kidd hemolytic disease and 1 case of Duffy hemolytic disease had jaundice and anemia, but did not reach the level of severe hyperbilirubinemia and severe anemia. MN hemolytic disease babies got negative results in direct antiglobulin test, whereas the Kidd and Duffy hemolytic disease babies had positive findings in direct antiglobulin test. None of the babies had blood transfusion, and they were discharged from the hospital.@*Conclusions@#Without maternal and fetal blood group incompatibility (ABO or Rh blood-group system), for early onset of jaundice, severe jaundice or anemia, antiglobulin test to mother and child earlier should be administered, and MN, Kidd, Duffy and other rare hemolytic disease of the newborn should be pay attention to.

Study on expression profile of long non-coding RNA in chronic thromboembolic pulmonary hypertension / 中华胸心血管外科杂志

Objective To investigate the aberrant expression of long non-coding RNA(lncRNA) in chronic thromboembolic pulmonary hypertension,and explore the lncRNA role in pathogenesis of CTEPH.Methods A total of 5 pulmonary artery endarterium tissue of CTEPH patients and 5 pulmonary artery endarterium tissue of healthy controls were collected.Using high-throughput gene microarray technology to detect two groups of lncRNA and mRNA expression spectrum,build lncRNA-mRNA express network,Pathway and GO analysis to explore the gene function.Results Differential expression of 185 lncRNA was observed in the CTEPH tissues compared with healthy control tissues.Further analysis identified 464 regulated enhancerlike lncRNA and overlapping,antisense or nearby mRNA pairs.Coexpression networks were subsequently constructed and investigated.The expression levels of the lncRNA,NR_036693,NR_027783,NR_033766 and NR_001284,were significantly altered.Gene ontology and pathway analysis demonstrated the potential role of lncRNA in the regulation of central process,including inflammatory response,response to endogenous stimulus and antigen processing and presentation.Conclusion Differentially expressed lncRNA may exert a partial role in CTEPH,the results of this study will help in the future about diagnosis and treatment of CTEPH.

Establishment and Analysis for Differential Gene Expression Profile of Left Atrium in Permanent Atrial Fibrillation Patients / 中国循环杂志

Objective: To explore the relevant gene, signaling pathway for permanent atrial fibrillation (pAF) occurrence in order to provide the molecular basis of the pathogenesis of pAF. Methods: Our research included in 2 groups: pAF group, n=7 patients and Control group, n=4 healthy subjects with sinus rhythm. Agilent 4x44K microarray was used to analyze the mRNA in left atrium for differential gene expression profile. Based on Gene Ontology, KEGG and Biocarta databases, differentially expressed genes were studied for their relevant function and signaling pathway. Furthermore, the genes with significant differences were verified by quantitative real time PCR (qRT-PCR) in pathological specimen from 5 pAF patients and 5 normal heart donors. Results: The expression profile identified 987 abnormally expressed genes, 567 of them were down-regulated and 420 were up-regulated. 9 genes with significant differences were verified by qRT-PCR in pathological specimen and the changes were similar to microarray; those genes were closely related to pAF by involving left atrium fibrosis, electrical remodeling, inflammation, cellular stress response, metabolism and transcription regulation. GO and Pathway analysis indicated that down-regulated genes were mainly involved in metabolic processes; up-regulated genes had the effects on cellular stress response, immune response and platelet activation. Conclusion: Microarray technology identified some important genes related to pAF occurrence; such genes involved in left atrial structural and functional remodeling via affecting cellular metabolism, inflammation, immune response and thrombogenesis in relevant patients.

Natural closing time of patent foramen ovale in newborns / 中华围产医学杂志

Objectives To investigate the closing time of patent foramen ovale in newborns and infants in order to provide appropriate follow-up time points.Methods From September 1,2010 to April 30,2011,131 of l 202 full-term infants with patent foramen ovale were finished follow up at 3,6 and 12 months of age in Beijing Children's Hospital,Capital Medical University.If the foramen ovale was not closed at 12 months of age,the patients were followed up until two years of age.The closing time and the effects of complicated patent ductus arteriosus (PDA) were analyzed statistically using two independent t test,Chi-square and trend Chi square tests.Results Of the 131 full-term infants with patent foramen ovale,72 were males,and 59 were females.The foramen ovale size in neonatal period was not statistically different between males and females [(2.94 ±0.86) vs (2.95 ± 0.92) mm,t=0.641,P=0.964].The foramen ovale closing rate at 3 months was 21.4％ (28/131),67.9％ (89/131) at 6 months,and 95.4％ (125/131) at 12 months.The rate of foramen ovale closing decreased with larger foramen ovale at 3,6 and 12 months of age (x2trend were 42.930,101.050 and 63.260,all P＜0.05).Six patients with patent foramen ovale at 12 months of age were followed up until 2 years of age:two cases with foramen ovale ＜5.0 mm in the neonatal period were closed,one of two cases with foramen ovale ≥5.0 but ＜6.0 mm was closed,and one of two cases with foramen ovale ≥ 6.0 mm was closed.Of the 131 cases,121 were simple patent foramen ovale,and l0 were complicated with PDA.There were no significant difference in neonatal foramen ovale size between children with simple patent foramen ovale and those with PDA [(2.95 ±0.88) vs (2.82±0.83) mm,t=0.782,P=0.649].The closing rates in the simple patent foramen ovale group at 3,6,and 12 months of age were 21.5％ (26/121),57.9％ (55/95) and 87.5％ (35/40),respectively,and showed no significant difference from those with PDA (2/10,6/8 and 1/2,x2=0.012,0.946 and 1.536,all P＞0.05).In the simple patent foramen ovale group,the closing rate at 3 months was less than that at 6 months and 12 months 0x2 were 10.410 and 62.515,both P＜0.01).There was no difference in the closing rate in patients with PDA at 3,6 and 12 months (x2=5.748,P＞0.05).Conclusions Asymptomatic patent foramen ovale with a foramen ovale ＜5.0 mm may not require follow-up.But patients with a foramen ovale ≥ 5.0 mm,even asymptomatic,should be followed up using thoracic echocardiography at 2 years,and further follow-up is required if unclosed.

Association of deep vein thrombosis with the efficacy of pulmonary thromboendarterectomy / 中华胸心血管外科杂志

Objective To retrospectively analysis whether the existence of deep vein thrombosis(DVT) in chronic thromboembolic pulmonary hypertension (CTEPH)) has an influence on the efficacy of pulmonary thromboendarterectomy.Methods The data of 75 patients with CTEPH having undergone PTE in Beijing Chaoyang Hospital from Sep 2004 to Mar 2016 were retrospectively reviewed.We classified them into two different groups which were DVT (+)group (32) and DVT (-) group (43) according to the present of DVT.Clinical data,hemodynamics,blood gas analysis and so on of both groups were compared.Results There were 1 patient died after PEA surgery in DVT(+)group and 7 patients died after PEA surgery in DVT (-) group(3.1％ vs 16.3％,P =0.033).The incidence of severe pulmonary reperfusion injury and the neurological disorders postoperatively in DVT(-) group was significantly higher than that in DVT(+) group (46.5 ％ vs 21.9％,P =0.028;32.6％ vs 12.5％,P =0.044).Compared with DVT(+) group,the content of C-react protein (CRP) was higher in DVT (-) group [(0.9 ± 0.7) mg/dl vs (0.5 ± 0.4) mg/dl,P =0.005].Furthermore,DVT(-) group had a significantly greater proportion of Jamieson Ⅲ or V than DVT(+) group,while the cardiopulnonary bypass time [(289.8 ± 54.3) min vs (259.8 ±45.5) min,P=0.014],aorta cross clamp time[(137.3 ±31.6) min vs(119.5±29.3) min,P=0.015] and deep hypothermia circulatory arrest were significantly longer in DVT(-) group than in DVT(+) group.Postoperative hemodynamics and blood gas index were obvious improved in both groups,but the postoperative pulmonary artery systolic pressure (PAPS) [(59.6 ± 17.9) mmHg vs (48.5 ± 9.7) mmHg,P =0.001],the pulmonary vascular resistance (PVR) [(30.44 ± 22.97) kPa · S · L-1 vs (18.34 ±8.09) kPa · S · L 1,P =0.002] in DVT(-) group were significantly higher than those in DVT(+) group.In addition,the incidence of residual pulmonary hypertension in DVT(-) group was significantly higher than in DVT(+) group.Conclusion Pulmonary thromboendarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement with favorable outcomes of heart and lung function.The recovery of the PAPS,PVR in patients with DVT are significantly better than those in patients without DVT,and the incidence of postoperative complication is significantly lower in patients with DVT.

Clinical research for patients with diabetes undergoing off-pump coronary artery bypass grafting by endoscopic saphenous vein harvesting / 中华胸心血管外科杂志

Objective To compare clinical effects and complications of patients with diabetes in off-pump coronary artery bypass grafting(OPCAB) between endoscopic saphenous vein harvesting(EVH) and conventional saphenous vein harvesting(CVH).Methods Sequence comparison analysis the clinical data of 339 patients with DM who underwent OPCAB in our department from Nov 2011 to Nov 2014.269 cases by EVH,70 cases by CVH.Observing two groups of patients with deprecated rate of SVG,intraoperative SVG blood flow and the value of PI,lower limb wound complications such as incision infection,poor healing,lower limb local hematoma and pain.SVG patency rate of part patients was follow-up by CT coronary angiography.Results To compare the two groups of patients by EVH and CVH,the perioperative death was 8 cases in EVH group (2.4％),2 cases in C VH group (2.9％).The deprecated SVG of patients was 3.9％ vs 2.9％.The blood flow was (17.36 ±11.24) ml/min vs(17.11 ± 8.37) ml/min,PI was 2.78 ± 2.37 vs 2.22 ± 2.17.The incision infection was 0 vs 4.4％,poor healing was 0.9％ vs 8.8％.The lower limb local hematoma was 5.7％ vs 1.5％.The visual pain analogue scale(VAS) was 0.53 ± 1.71 vs 1.26 ± 2.13 3 days after operation.The numbness of lower limb was 9.7％ vs 22.1％.The Edema of the legs was 8.5％ vs 19.1％ 7 days after operation.60 cases were follow-up by CT coronary angiography,the SVG patency rate was91.4％ vs 94.6％ 1 year after operation,83.3％ vs 86.1％ 2 years after operation,72.2％ vs 73.7％ 3 years after operation respectively.Conclusion EVH technology for SVG in the patients combined DM has good clinical result,the recent patency rate of SVG is perfect,postoperative limb complications is decreased by EVH.

Impact of Intraoperative Blood Pressure Control and Temporary Parent Artery Blocking on Prognosis in Cerebral Aneurysms Surgery / 中国医学科学杂志(英文版)

Objective In cerebral aneurysm clipping and embolization, blood pressure control and temporary parent artery blocking are common methods to prevent aneurysm rupture. Their influence on the prognosis is uncertain. In this study, we try to find out the association between methods above and prognostic indicators.Methods We held a retrospective analysis on patients' medical records of cerebral aneurysms surgical clipping and endovascular coiling , and recorded gender, age, diagnosis, Hunt-Hess grade, Glasgow coma scale score, treatment methods, a history of hypertension, preoperative systolic blood pressure, with or without controlled hypotension, systolic blood pressure difference before and after controlled hypotension, with or without temporary artery blocking, with or without hypertension after treated aneurysm, prognostic indicators including mortality after 1 month, intensive care unit (ICU) stay time of survivors, discharged Glasgow outcome scale (GOS) score. Prognostic indicators were regarded as dependent variable, all the factors were regarded as independent variable, and the strength analysis of influence factors on prognostic indicators was made by binary logistic regression.Results Total cases were 165, including 68 males and 97 females, with an average age of 56 (12-85) years. The mortality after 1 month was 10.9% (18 cases). The ICU stay time of survivors was 7.35 (0-67) days. GOS score at discharge was 1-3 in 40 (24.2%) patients and 4-5 in 125 (75.8%) patients. Systolic blood pressure difference before and after controlled hypotension was an independent factor influencing mortality (t=2.273, P=0.024), and the greater the difference was, the higher the mortality would be. Timely hypertension after aneurysm treated was an independent factor affecting ICU stay time of survivors and patients with hypertension had shorter ICU stay time (χ=10.017, P=0.001). Blood pressure control (χ=0.088, P=0.767) and temporary blocking (χ=1.307, P=0.253) did not show significant influence on GOS score at discharge.Conclusions Timely controlled hypertension after aneurysm clipping and embolization can significantly shorten the stay time in ICU. The degree of controlled hypotension associates with postoperative mortality, the greater systolic blood pressure difference before and after antihypertensive treatment is, the higher the mortality will be.

Clinical characteristics of neonatal hemolytic disease of anti-M or Rhesus system / 中华围产医学杂志

ObjectiveTo analyze the clinical manifestation of hemolytic disease of the newborn (HDN) due to anti-M and Rhesus system.MethodsClinical information was collected and analyzed for three cases with HDN due to anti-M and 64 with Rhesus hemolytic disease, who were admitted to Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medical University from February 2011 to January 2015, as well as another 28 cases of HDN due to anti-M with complete information retrieved from literature in Wanfang and China National Knowledge lnfrastructure (CNKI) Database from 1992 to 2014.Chi-square test was performed for statistical analysis.ResultsTwo out of the 64 Rh hemolytic babies gave up therapy due to kernicterus and another two out of the 31 MN hemolytic babies, obtained from literature, died 24 h after birth because of anemia or edema, while the rest survived. Although more babies were the first child of the family in HDN due to anti-M than those of Rh hemolytic disease [26%(8/31) vs 9%(6/64),χ2=4.487, P=0.034], but lower incidence of jaundice [81%(25/31) vs 98%(63/64),χ2=9.686,P=0.002], less proportion of presentation of jaundice within 24 h after birth [29% (9/31) vs 64%(41/64),χ2=10.279,P=0.001] and lower positive rate of direct antiglobulin test [39%(12/31) vs 100%(64/64), Fisher exact test,P=0.000] were shown in HDN due to anti-M. No significant difference was found in the incidences of hyperbilirubinemia [58%(18/31) vs 66%(42/64),χ2=0.513], severe hyperbilirubinemia [23%(7/31) vs 36%(23/64),χ2=1.724], anemia [81%(25/31) vs 89%(57/64),χ2=1.253] and severe anemia [29%(9/31) vs 34%(22/64),χ2=0.271] between HDN due to anti-M and Rh hemolytic babies (allP>0.05).ConclusionsHDN due to anti-M and Rhesus hemolytic disease can cause severe pathological jaundice and/or anemia in newborns. Indirect antiglobulin test should be offered when direct antiglobulin test is negative which is helpful in the diagnosis of HDN due to anti-M.

Pulmonary endarterectomy in 50 patients with chronic thromboembolic pulmonary hypertension: experience and doubts / 中华胸心血管外科杂志

Objective To evaluate the feasibility,validity and safety of pulmonary endarterectomy for patients with chronic thromboembolic pulmonary hypertension.Methods 50 patients undertook pulmonary endarterectomy operations were enrolled in this study.Of them,38 were males (76％),the average age was (43.35 ± 12.51) years,23 patients had deep venous thrombosis.Obvious pulmonary hypertension and hypoxemia were observed in all patients.Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest.Preoperative systolic pulmonary artery pressure was(104.16 ± 16.95) mmHg,pulmonary vascular resistance was(129.68 ± 50.88) kPa · s · L-1,central venous pressure was (14.91 ± 4.88) mmHg,and cardiac output was (3.28 ± 1.04) L/min.Results The average time of cardiopulmonary bypass was(294.37 ± 94.01) min,aortic cross clamp time was(127.93 ± 35.57) min,circulatory arrest time was(34.30 ±21.74) min.Post-operative mechanical ventilation time was (97.24 ±70.53) hours,and the ICU stay was (9.52 ± 12.96) days.There were 4 patients that died after PEA surgery for postoperative residual pulmonary hypertension of reperfusion pulmonary edema.Post-operation,all patients had significant decrease in systolic pulmonary artery pressure (54.11 ± 16.86) mmHg and pulmonary vascular resistance(20.55 ± 15.17) kPa · s · L-1,and central venous pressure (9.00 ± 3.09) mmHg,and great improvement in cardiac output (5.75 ± 1.48) L/min.6-months follow-up showed that the cardiac function of 44 (95.7 ％) cases returned to NYHA class Ⅰ or Ⅱ,with great improvement in computed tomography pulmonary angiography.All patients go back to normal work and physical exercise at 1-year follow-up.Conclusion Conclusions According the successful experience of surgery for CTEPH patients,pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement,with favorable outcomes of heart and lung function in short and middle time follow-up.

Clinical efficacy of simple obesity treated by catgut implantation at acupoints / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the clinical effificacy of treatment with catgut implantation at acupoints on simple obesity.</p><p><b>METHODS</b>Following the theory of Chinese medicine (CM), pattern identification (PI) and treatment was based on the patient's symptoms and signs. Patients were observed during three courses and one year following treatment through self-comparison before and after six or seven acupoints catgut implantation. Obesity was divided into fifive types based on PI: (1) Stomach (Wei) and Intestine excess-heat, (2) Spleen (Pi) defificiency and phlegmwet stagnancy, (3) Liver (Gan)-qi stagnation, (4) Spleen-Kidney (Shen) yang deficiency, and (5) Liver-Kidney yin defificiency. Changes in the following measurements were recorded in 820 patients: body weight, body girth, skinfold thickness, body mass index (BMI), fat percentage (F%) and waist/hip ratio (WHR) and in the following blood values: leptin (LP), insulin (INS), blood lipids, fasting blood sugar (FBS), and insulin sensitive index (ISI) before and after the treatment. Values were compared with those of healthy controls (normal group).</p><p><b>RESULTS</b>Catgut implantation showed effificacy with all fifive types of obesity. Effificacy was greater in males than in females. There was no signifificant difference between the different types by Kruskal-Wallis H test, but the effect was best and of the highest number in patients with Stomach and Intestine excess-heat. Skin-fold thickness, body weight, waist circumference, F%, BMI, and WHR in all 820 cases decreased after treatment (at 90 days and one year), with signifificant differences before and after treatment (P<0.01). Improved metabolism of blood lipids was also seen. Following treatment, LP, INS, and FBS decreased signifificantly (P<0.01) and ISI increased signifificantly (P<0.05).</p><p><b>CONCLUSION</b>Catgut implantation at acupoints provided effective and persistent results, convenience, safety, painlessness, and prolonged effect with no side effects, resulting in reduced body weight and fat and improvement in body shape.</p>

Serum Bilirubin and 6-min Walk Distance as Prognostic Predictors for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Prospective Cohort Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is a severe clinical syndrome characterized by right cardiac failure and possibly subsequent liver dysfunction. However, whether serum markers of liver dysfunction can predict prognosis in inoperable CTEPH patients has not been determined. Our study aimed to evaluate the potential role of liver function markers (such as serum levels of transaminase, bilirubin, and gamma-glutamyl transpeptidase [GGT]) combined with 6-min walk test in the prediction of prognosis in patients with inoperable CTEPH.</p><p><b>METHODS</b>From June 2005 to May 2013, 77 consecutive patients with inoperable CTEPH without confounding co-morbidities were recruited for this prospective cohort study. Baseline clinical characteristics and 6-min walk distance (6MWD) results were collected. Serum biomarkers of liver function, including levels of aspartate aminotransferase, alanine aminotransferase, GGT, uric acid, and serum bilirubin, were also determined at enrollment. All-cause mortality was recorded during the follow-up period.</p><p><b>RESULTS</b>During the follow-up, 22 patients (29%) died. Cox regression analyses demonstrated that increased serum concentration of total bilirubin (hazard ratio [HR] = 7.755, P < 0.001), elevated N-terminal of the prohormone brain natriuretic peptide (HR = 1.001, P = 0.001), decreased 6MWD (HR = 0.990, P < 0.001), increased central venous pressure (HR = 1.074, P = 0.040), and higher pulmonary vascular resistance (HR = 1.001, P = 0.018) were associated with an increased risk of mortality. Serum concentrations of total bilirubin (HR = 4.755, P = 0.007) and 6MWD (HR = 0.994, P = 0.017) were independent prognostic predictors for CTEPH patients. Patients with hyperbilirubinemia (≥23.7 μmol/L) had markedly worse survival than those with normobilirubinemia.</p><p><b>CONCLUSION</b>Elevated serum bilirubin and decreased 6MWD are potential predictors for poor prognosis in inoperable CTEPH.</p>

Clinical characteristics of whooping cough in neonates and antimicrobial resistance of the pathogenic bacteria / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics of whooping cough in neonates and the antimicrobial resistance of the bacterial isolates.</p><p><b>METHODS</b>Clinical information of 7 neonates with whooping cough confirmed by bacterial culture was collected. The antimirobial resistance of the isolates was tested using E-test and disk diffusion methods.</p><p><b>RESULTS</b>The children′s mothers or other family members had cough for more than 10 days in 6 neonates, in which four neonates contacted with 3 or more family members with cough. All the neonates had rhinobyon and slight cough at the beginning of the disease. Five cases presented typical spasmodic cough after 4-7 days of the onset. Five cases displayed cyanosis, four cases occurred apnea, three cases suffered breath holding, and only two cases had fever. Nares flaring and three depression signs were found in the physical examination. No bacteriostatic ring around the erythromycin disks were found for five bacterial isolates. The minimal inhibitory concentration (MIC) for erythromycin, azithromycin, clarithromycin and clindamycin were all >256 mg/L against the five isolates.</p><p><b>CONCLUSIONS</b>Whooping cough should be considered for neonates with respiratory symptoms and a history of close contact with respiratory infection patients. Macrolide-resistant Bordetella pertussis is common in children with whooping cough.</p>

Effects of cuttlefish bone-bone morphogenetic protein composite material on osteogenesis and revascularization of bone defect in rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effects of cuttlefish bone-bone morphogenetic protein (BMP) composite material on osteogenesis and revascularization of bone defect in rats.</p><p><b>METHODS</b>The cuttlefish bone was formed into cylinder with the diameter of about 5 mm and height of about 2 mm after the shell was removed, and then it was soaked in the recombinant human BMP 2 to make a cuttlefish bone-BMP (CBB) composite material. Thirty SD rats, with a defect of skull in every rat, were divided into the CBB and pure cuttlefish bone (PCB) groups according to the random number table, with 15 rats in each group. The rats in the group CBB and group PCB were transplanted with the corresponding material to repair the skull defect. At post transplantation week (PTW) 4, 6, and 8, 5 rats from every group were sacrificed by exsanguination, and ink perfusion was performed. One day later, all the transplants and part of the skull surrounding the defect were harvested, and general observation was conducted at the same time. The specimens were paraffin sectioned for HE staining and Masson staining. The area of microvessel and the area of newborn bone were observed and analyzed through histopathological techniques and image collection system. Data were processed with the analysis of variance of factorial design and LSD test. The correlation between the area of microvessel and the area of newborn bone of the group CBB was analyzed with Pearson correlation analysis.</p><p><b>RESULTS</b>(1) The general observation of the transplant region showed that the transplants were encapsulated by a capsule of fibrous connective tissue. The texture of capsule was soft and relatively thick at PTW 4. The texture was tenacious and thin, but rather compact at PTW 6 and 8. The transplants became gelatinous at PTW 4, and similar to the cartilage tissue at PTW 6 and 8. (2) Histological observation showed that the structure of the transplants in two groups was damaged at PTW 4. A moderate quantity of inflammatory cell infiltration could be observed. The amounts of the primary bone trabeculae and microvessels in group CBB were more abundant than those of group PCB, while the number of osteoclasts was less than those of group PCB. At PTW 6, the inflammatory cell infiltration in the transplants in both groups decreased obviously, the cuttlefish bone was found to be further degraded, and the number of newborn microvessels was increased. There were mature bone trabeculae around the transplants in both groups. And there were also mature bone trabeculae in the degraded CBB in group CBB. At PTW 8, the inflammatory reaction in the transplants in both groups disappeared; there were more mature bone trabeculae; the structure of the cuttlefish bone was found to be damaged basically. Bone trabeculae in group PCB were found around the transplant, while the bone trabeculae could be observed not only around the transplant but also in the degraded CBB in group CBB. The amount of the microvessels in group CBB was still larger than that of group PCB. (3) From PTW 4 to 8, the area of microvessel in group CBB [(63 ± 4), ( 136 ± 36), ( 347 ± 31) µm(2)] was larger than that in group PCB [(44 ± 7), (73 ± 4), (268 ± 42) µm(2), P < 0.05 or P < 0.01]. From PTW 4 to 8, the area of newborn bone in group CBB [(236 ± 26), (339 ± 42), (553 ± 40) µm(2)] was larger than that in group PCB [(137 ± 15), (243 ± 21), (445 ± 29) µm(2), with P values all below 0.01]. (4) The relation between the area of microvessel and the area of newborn bone was significantly positive (r = 0.948, P = 0.001).</p><p><b>CONCLUSIONS</b>The CBB may exert good effect on osteogenesis and vascularization of rats with bone defect. It is a good three dimensional scaffold in bone tissue engineering.</p>